Cerebral tinnitus is a symptom characterized by the perception of ringing sounds in the head.

Mingyi Lei'an refers to it as "head ringing," Zabing Yuanliu Xizhu calls it "head cerebral tinnitus ringing."

Ancient people believed that cerebral tinnitus is the main symptom of "thunder-headache," as mentioned in Zhengzhi Zhunsheng Zabing: "Thunder-headache is when a headache arises with a lump. Some say the head rings like thunder. It is caused by wind evil, and when the wind moves, it produces sound." This describes a rare clinical condition where a lump forms in the head and the brain produces thunder-like sounds. In modern times, there have been reports of tumors in the brain causing such ringing, which is considered a severe form of cerebral tinnitus.

In ancient times, cerebral tinnitus was rarely discussed alone; it was often discussed alongside tinnitus, as in Mingyi Lei'an．Shoufeng: "Head ringing tinnitus, top of the head pain, dizzy vision, ... caused by liver fire." The two can occur simultaneously but are distinct. This section focuses specifically on cerebral tinnitus.

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1. Insufficiency of the Sea of Marrow︰cerebral tinnitus, soreness in the waist and weakness in the legs, seminal emission, dizziness, dizzy vision tinnitus, tongue texture pale with scant coating, pulse deep, thin, and weak. Constitution inherently deficient, aging renal failure, or excessive indulgence damaging essence, prolonged illness depleting the kidneys, all lead to kidney essence deficiency, failing to generate marrow, resulting in brain marrow emptiness and thus tinnitus. Kidney deficiency prevents yin essence from ascending to the brain, causing dizziness, dizzy vision tinnitus; the waist is the residence of the kidneys, the kidneys govern the bones, kidney deficiency leads to soreness in the waist and weakness in the legs; the kidneys govern the storage of essence, kidney deficiency results in unsecured essence gate and thus seminal emission; pale red tongue texture without coating is a sign of kidney essence insufficiency, deep, thin, and weak pulse is a manifestation of kidney qi deficiency and decline. Treatment should focus on enriching and tonifying kidney essence, using Left-Restoring Pill, Great Life-Endowing Pill. Kidney deficiency and insufficiency of the sea of marrow lead to cerebral tinnitus accompanied by soreness in the waist, weakness in the legs, and seminal emission.
2. Deficiency of Both Heart and Spleen︰cerebral tinnitus vertigo, insomnia dreamfulness, shortness of breath lack of strength, palpitation forgetfulness, anorexia reduced food intake, or loose stool edema, tongue texture pale, coating thin white, pulse manifestation soggy and thin. It arises from overstrain or chronic illness leading to deficiency, dual deficiency of qi and blood, failing to nourish the seven orifices, hence cerebral tinnitus vertigo. Blood failing to nourish the heart results in insomnia dreamfulness, palpitation forgetfulness; insufficiency of middle qi leads to shortness of breath lack of strength, anorexia reduced food intake, loose stool; pale tongue with thin white coating, pulse manifestation soggy and thin, all are signs of qi and blood deficiency. Treatment should focus on tonifying and replenishing the heart and spleen, using Returning to Spleen Decoction.
3. Dampness-heat︰cerebral tinnitus, headache, heaviness of the head as if wrapped, vertigo, nausea and vomiting, anorexia, or head tumors, red tongue texture, yellow greasy coating, slippery and rapid pulse. It arises from prolonged consumption of rich and greasy foods or alcohol, leading to the accumulation of dampness-heat that rises and stagnates in the head, obstructing the meridians and forming tumors, resulting in cerebral tinnitus. There is often a gradual worsening of headache, fixed in location, accompanied by vertigo, nausea and vomiting, or head tumors, and a yellow greasy tongue coating.
4. Liver Qi Depression︰Cerebral tinnitus is particularly aggravated by anger, with distending pain in both flanks, irritability, chest tightness, frequent sighing, bitter taste in the mouth, dry throat, red tongue tip, thin white or thin yellow tongue coating, and wiry pulse. It arises after intense anger, due to liver qi stagnation and impaired ascending-descending dynamics, leading to dysfunction of the seven orifices, hence causing cerebral tinnitus. During diagnosis, it often worsens with anger and is accompanied by symptoms of liver depression such as flank distension and chest tightness, making the two syndromes easily distinguishable. For cases of dampness-heat obstruction, treatment should focus on clearing heat and resolving dampness, removing toxin and dispelling stasis to unblock collaterals. The recommended formula is Coptis Decoction combined with blood-activating and stasis-resolving herbs. If a brain tumor is suspected, follow-up examinations should be emphasized. For liver qi stagnation, the treatment should aim at soothing the liver and relieving depression. The formula Peony and Gardenia Peripatetic Powder can be modified accordingly, and the patient should avoid anger.

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1. 《Zhengzhi Yaojue．vertigo》: "There is a sound like the chirping of birds on the head, ... this is caused by wind in the brain."
2. Linzheng Zhinan Yi'an ．liver wind》: "Palpitation flutters, ringing in the head, frequently occurring for seven or eight years without stopping, daily life and diet as usual. This is the automatic internal wind of the liver and gallbladder, suitable for calming substances."
3. Zabing Yuanliu Xizhu ．recurrent headache》: "There is cerebral tinnitus in the head, sounding like insects gnawing, called Tianyi, suitable for blowing tea powder into the nose for effect."